Sucato Daniel J, De La Rocha Adriana, Lau Karlee, Ramo Brandon A
Texas Scottish Rite Hospital for Children, Dallas, TX.
J Pediatr Orthop. 2017 Mar;37(2):e108-e113. doi: 10.1097/BPO.0000000000000747.
Preoperative Bryant's overhead traction before closed reduction (CR) in developmental dysplasia of the hip (DDH) remains controversial and its success in increasing CR rates and reducing avascular necrosis (AVN) rates has not been specifically reported in a large cohort.
IRB-approved retrospective study of patients (below 3 y)who were treated with attempted CR for idiopathic DDH from 1980 to 2009. Successful CR was defined as a hip that remained reduced and did not require repeat CR or open reduction. Patients were grouped by age, hip instability [Ortolani positive (reducible) vs. fixed dislocation], and Tonnis classification and rates of successful CR were compared between groups with P<0.05.
A total of 342 hips were included with a mean age of 0.9 years (0.2 to 2.8 y) and a mean follow-up of 10.4 years (2.0 to 27.7 y). There were 269 hips with fixed dislocations and 73 Ortolani-positive hips. Traction was used in 276 hips. There was no difference in traction utilization in the 3 age groups (below 1, below 1.5, and below 2 y) for either Ortolani-positive hips (P=0.947) or fixed dislocations (P=0.943). There was no difference in achieving a successful CR comparing traction (60.9%) and no-traction groups (60.6%) (P=1.00). For Ortolani-positive hips, traction did not improve the incidence of a successful CR for any age group: below 1 year: P=0.19; below 1.5 years: P=0.23; and below 2 years: P=0.25. Similarly, fixed dislocation patients had no benefit from traction: below 1 year: P=0.76; below 1.5 years: P=0.82; and below 2 years: P=0.85. Tonnis classification did predict success of CR but had no influence on traction success. There was no difference in the rate of AVN between the traction (18%) and no-traction (8%) groups for all patients (P=0.15).
In this retrospective series, preoperative Bryant's traction does not improve the rate of a successful CR for patients with DDH and has no protective effect on the development of AVN of the femoral head. These results suggest that Bryant's overhead traction may not be warranted for patients below 3 years of age with DDH.
Level III.
在发育性髋关节发育不良（DDH）的闭合复位（CR）之前进行术前布莱恩特悬吊牵引仍存在争议，并且其在提高CR成功率和降低股骨头缺血性坏死（AVN）发生率方面的成效尚未在大型队列研究中得到专门报道。
对1980年至2009年因特发性DDH接受CR治疗的3岁以下患者进行了经机构审查委员会批准的回顾性研究。成功的CR定义为髋关节保持复位状态且无需再次CR或切开复位。根据年龄、髋关节不稳定情况[奥尔托拉尼试验阳性（可复位）与固定性脱位]以及托尼分类对患者进行分组，并比较组间成功CR的发生率，P<0.05具有统计学意义。
共纳入342例髋关节，平均年龄0.9岁（0.2至2.8岁），平均随访10.4年（2.0至27.7年）。其中269例为固定性脱位髋关节，73例为奥尔托拉尼试验阳性髋关节。276例髋关节使用了牵引。在奥尔托拉尼试验阳性髋关节（P=0.947）或固定性脱位髋关节（P=0.943）的3个年龄组（1岁以下、1.5岁以下和2岁以下）中，牵引的使用情况没有差异。牵引组（60.9%）和非牵引组（60.6%）在实现成功CR方面没有差异（P=1.00）。对于奥尔托拉尼试验阳性髋关节，牵引对任何年龄组的成功CR发生率均无改善：1岁以下：P=0.19；1.5岁以下：P=0.23；2岁以下：P=0.25。同样，固定性脱位患者也未从牵引中获益：1岁以下：P=0.76；1.5岁以下：P=0.82；2岁以下：P=0.85。托尼分类确实可预测CR的成功，但对牵引成功率没有影响。所有患者中，牵引组（18%）和非牵引组（8%）的AVN发生率没有差异（P=0.15）。
在这个回顾性系列研究中，术前布莱恩特牵引并不能提高DDH患者成功CR的发生率，对股骨头AVN的发生也没有保护作用。这些结果表明，对于3岁以下的DDH患者，可能无需进行布莱恩特悬吊牵引。
三级。
